Patients managed with an early invasive strategy: 2 trials - ACUITY (biva alone vs hep+aGP2b3a) - ACUITY (biva+aGP2b3a vs hep+aGP2b3a)
| bivalirudin vs heparin + GP2b3a inhibitors | No demonstrated result suggested major bleeding TIMI by 50% (not demonstrated) suggested ischemic events + bleeding by 14% (not demonstrated) suggested Major bleeding by 23% (not demonstrated) suggested major bleeding not related to CABG by 47% (not demonstrated) | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| death, MI, unplanned revascularization | 1.08 [0.92 1.26] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | major bleeding TIMI | 0.50 [0.35 0.72] | p=0.04 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | ischemic events + bleeding | 0.86 [0.76 0.99] | p=0.04 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | 1 year death from any cause | 0.98 [0.79 1.22] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | 1 year MI | 1.12 [0.96 1.32] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | 1 year unplanned revascularization for ischemia | 1.04 [0.90 1.21] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | 1 year composite ischemia | 1.05 [0.94 1.18] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | myocardial infarction (fatal and non fatal) | 1.09 [0.91 1.31] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | All cause death | 1.19 [0.85 1.67] | p=1.00 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | Major bleeding | 0.77 [0.68 0.89] | p=0.04 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), | | major bleeding not related to CABG | 0.53 [0.43 0.65] | p=0.04 | 0 | 9215 | 1 | ACUITY (biva alone vs hep+aGP2b3a), |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin + GP2b3a inhibitors vs heparin + GP2b3a inhibitors | No demonstrated result | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| death, MI, unplanned revascularization | 1.07 [0.91 1.24] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | major bleeding TIMI | 0.88 [0.65 1.21] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | ischemic events + bleeding | 1.01 [0.89 1.14] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | 1 year death from any cause | 1.01 [0.81 1.25] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | 1 year MI | 1.03 [0.88 1.21] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | 1 year unplanned revascularization for ischemia | 1.09 [0.94 1.26] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | 1 year composite ischemia | 1.04 [0.93 1.17] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | myocardial infarction (fatal and non fatal) | 1.01 [0.84 1.22] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | All cause death | 1.13 [0.80 1.59] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | Major bleeding | 0.94 [0.83 1.07] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), | | major bleeding not related to CABG | 0.93 [0.77 1.11] | p=1.00 | 0 | 9207 | 1 | ACUITY (biva+aGP2b3a vs hep+aGP2b3a), |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
PCI sub group: 2 trials - ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé - ACUITY (sub groups PCI, bivalirudin alone) importé
| bivalirudin vs heparin + GP2b3a inhibitors | No demonstrated result suggested major bleeding TIMI by 45% (not demonstrated) suggested TIMI minor bleeding by 63% (not demonstrated) suggested Major bleeding by 48% (not demonstrated) | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| all cause death, MI, stroke | no data | | Urgent target-vessel revascularization | no data | | Major or minor TIMI bleeding | no data | | death, MI, unplanned revascularization | 1.07 [0.88 1.30] | p=1.00 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | cardiovascular events | no data | | Cardiovascular death | no data | | myocardial infarction (fatal and non fatal) | 1.15 [0.92 1.45] | p=1.00 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | Stent thrombosis (any, end of follow up) | no data | | All cause death | 1.19 [0.68 2.07] | p=1.00 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | major bleeding TIMI | 0.55 [0.43 0.70] | p=0.04 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | TIMI minor bleeding | 0.37 [0.23 0.61] | p=0.04 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | Major bleeding | 0.52 [0.40 0.67] | p=0.04 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, | | ischemic events + bleeding | 0.87 [0.74 1.03] | p=1.00 | 0 | 5180 | 1 | ACUITY (sub groups PCI, bivalirudin alone) importé, |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin + GP2b3a inhibitors vs heparin + GP2b3a inhibitors | No demonstrated result | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| all cause death, MI, stroke | no data | | Urgent target-vessel revascularization | no data | | Major or minor TIMI bleeding | no data | | death, MI, unplanned revascularization | 1.14 [0.94 1.38] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | cardiovascular events | no data | | Cardiovascular death | no data | | myocardial infarction (fatal and non fatal) | 1.17 [0.93 1.47] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | Stent thrombosis (any, end of follow up) | no data | | All cause death | 1.28 [0.74 2.21] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | major bleeding TIMI | 1.07 [0.74 1.53] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | TIMI minor bleeding | 1.08 [0.88 1.33] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | Major bleeding | 1.11 [0.89 1.37] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, | | ischemic events + bleeding | 1.12 [0.96 1.31] | p=1.00 | 0 | 5170 | 1 | ACUITY (sub groups PCI, bivalirudin +aGP2b3a) importé, |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin vs heparin + GP2b3a inhibitors | No demonstrated result suggested Minor bleeding by 38% (not demonstrated) suggested Bleeding by 40% (not demonstrated) suggested Major bleeding by 39% (not demonstrated) suggested net benefit by 24% (not demonstrated) | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| Unplanned revascularisation for ischaemia | 1.34 [0.86 2.09] | p=1.00 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | death, MI, unplanned revascularization | 0.99 [0.74 1.32] | p=1.00 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | myocardial infarction (fatal and non fatal) | 1.14 [0.64 2.03] | p=1.00 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | MACE | 0.99 [0.74 1.32] | p=1.00 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | All cause death | 0.66 [0.43 1.01] | p=1.00 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | Minor bleeding | 0.62 [0.44 0.89] | p=0.04 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | Bleeding | 0.60 [0.46 0.78] | p=0.04 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | Major bleeding | 0.61 [0.43 0.85] | p=0.04 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), | | net benefit | 0.76 [0.62 0.94] | p=0.04 | 0 | 3602 | 1 | HORIZONS-AMI (Stone), |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin vs UFH | No demonstrated result suggested Major bleeding by 61% (not demonstrated) | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| Unplanned revascularisation for ischaemia | 0.92 [0.59 1.43] | p=1.00 | 0 | 5154 | 2 | REPLACE-1,BAT (Bittl), | | death, MI, unplanned revascularization | 0.82 [0.50 1.35] | p=1.00 | 0 | 1056 | 1 | REPLACE-1, | | myocardial infarction (fatal and non fatal) | 0.84 [0.63 1.12] | p=1.00 | 0 | 5154 | 2 | REPLACE-1,BAT (Bittl), | | MACE | 0.93 [0.77 1.13] | p=1.00 | 0 | 4098 | 1 | BAT (Bittl), | | All cause death | 1.53 [0.51 4.57] | p=1.00 | 0 | 5154 | 2 | REPLACE-1,BAT (Bittl), | | Minor bleeding | no data | | Bleeding | no data | | Major bleeding | 0.39 [0.30 0.50] | p=0.04 | 0 | 4098 | 1 | BAT (Bittl), | | net benefit | no data |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin vs UFH plus tirofiban | No demonstrated result suggested Minor bleeding by 58% (not demonstrated) | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| Unplanned revascularisation for ischaemia | 1.01 [0.02 51.00] | p=1.00 | 0 | 335 | 1 | NAPLES (Tavano), | | death, MI, unplanned revascularization | no data | | myocardial infarction (fatal and non fatal) | no data | | MACE | no data | | All cause death | 1.01 [0.02 51.00] | p=1.00 | 0 | 335 | 1 | NAPLES (Tavano), | | Minor bleeding | 0.42 [0.21 0.84] | p=0.04 | 0 | 335 | 1 | NAPLES (Tavano), | | Bleeding | no data | | Major bleeding | 0.25 [0.03 2.27] | p=1.00 | 0 | 335 | 1 | NAPLES (Tavano), | | net benefit | no data |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| bivalirudin + eptifibatide vs heparin + GP2b3a inhibitors | No demonstrated result | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| Unplanned revascularisation for ischaemia | no data | | death, MI, unplanned revascularization | no data | | myocardial infarction (fatal and non fatal) | no data | | MACE | no data | | All cause death | no data | | Minor bleeding | no data | | Bleeding | no data | | Major bleeding | no data | | net benefit | no data |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
| Prasugrel and Bivalirudin vs Clopidogrel and Heparin | No demonstrated result | | Endpoint | TE [95% CI] | p val | I2 | n | k | trials |
|---|
| cardiovascular events | no data | | Cardiovascular death | no data | | myocardial infarction (fatal and non fatal) | no data | | stroke (fatal and non fatal) | no data | | MACE | no data | | All cause death | no data | | Major bleeding | no data | | net benefit | no data | | stent thrombosis | no data |
TE: treatment effect; CI: confidence interval; k: nulmber of trials; n: total number of patients |
